On 31 December 2019, there was an unknown cause that gave rise to pneumonia cases in Wuhan City, China. It was not long until the World Health Organization (WHO) was informed of a new Coronavirus Disease, which is known as COVID-19, until present 2021.

This infectious disease infects human beings, leading to them experiencing mild to moderate respiratory illness and recovering without requiring special treatment. 

However, there are cases where elderly and population with underlying medical conditions such as cardiovascular disease, diabetes mellitus, respiratory disease, and cancer are more prone to develop serious symptoms.

Covid-19 has been existing from 2019 until the present day, there have been plenty of questions and doubts regarding this disease. Here are 8 myths and facts about this highly infectious disease that were found to be closely related to our daily life.

1. Can Covid-19 virus be transmitted through goods, cash and groceries?

• Yes. Covid viruses can stay on the surface for many hours and up to days. Examples such as metal products can have the virus survive up to 9 days, woods up to 4 days, plastic surface up to 3 days and etc.
• Thus, it is better to be safe than sorry. It is strongly suggested to disinfect items’ surfaces and frequently-touched objects using a disinfecting spray or wipe.
• As for groceries such as fruits and vegetables, rinsing them in cold water or cleaning with vegetable brushes are adequate. Using disinfecting spray, wipe or soap can lead to possible food poisoning.

3. Is the virus able to stick to our clothes and shoes?

• There’s not much research about how long the virus lives on fabric.
• The possibility of COVID-19 being spread on shoes and infecting individuals is very low as well. As a safeguard, especially when there are infants and small children crawling or playing on floors, do remove the shoes before entering home.
• It is also recommended that proper hygiene needs to be practised, besides from showering every day, clothes should be washed with detergent or soap in 60-90 ⁰C water, drying clothes under a hot sun or in a high temperature dryer can help to kill the virus as well.

4. Can Covid-19 be prevented by rinsing the nasal cavity with saline solution? Besides, is gargling with mouthwash, warm water with salt or vinegar solution proven to prevent viruses and other things to travel into the throat and lung?

• Evidence has shown that rinsing the nose with saline solution can help the patient to recover faster from the common cold symptoms, but unable to prevent Covid-19 and other infectious respiratory diseases such as pneumonia.
• Moreover, the Centers for Disease Control and Prevention (CDC) suggested that gargling with warm salty water can help with soothing a sore throat, but not effective in stopping infection with Covid-19.

5. Are there any medications that can prevent and cure Covid-19? 

• There has been news where medications such as oral steroids, hydroxychloroquine, azithromycin and Ivermectin are claimed to be able to treat or prevent Covid-19.
• Oral steroids such as Dexamethasone have anti-inflammatory and immunosuppressive effects, which only should be used for Covid-19 patients with severe and critically ill conditions. For some Covid-19 patients on ventilators, a daily 6 mg dose of dexamethasone for 10 days may improve their health.
• Dexamethasone provides no improvement for patients with mild symptoms.
• As for hydroxychloroquine and azithromycin, randomized clinical trials and studies have been conducted to evaluate the safety and efficacy of these medications.
• In conclusion, The COVID-19 Treatment Guidelines Panel does not recommend the use of azithromycin, chloroquine, or hydroxychloroquine for the treatment of COVID-19 in both hospitalised and non-hospitalised patients.
• On the other hand, while initial research is still ongoing, FDA has neither approved nor supported the use of ivermectin to treat or to prevent COVID-19.
• All in all, currently there is no drug approved that is able to prevent and treat Covid-19 disease and taking a drug for an unapproved use can be very dangerous. Misinformation and misuse of medications can lead to overdose, side effects and contraindications that can be fatal. Patients with covid symptoms should receive proper and supportive care to alleviate the symptoms.

6. Can drinking alcohol or eating garlic help to prevent Covid-19?

• Drinking alcoholic beverages, such as wine, beer or liquor doesn’t help to prevent Covid-19. Besides, alcohol is known to harm human health and is associated with a range of diseases. Alcohol can also compromise one’s immune system; increase the risk of adverse health outcomes, leading to the person more vulnerable to Covid virus. 
• Garlic, though is known to have antimicrobial properties and used in public to prevent disease such as cold, there has been no evidence that it can help to prevent or cure Covid-19.

7. Do UV bulbs, disinfectants such as bleach or chlorine help to kill Covid-19 viruses on our body?

• First of all, it does not help with killing the virus inside the body. Besides, do not use UV bulbs, high concentration alcohol or chlorine on your hands or any part of the body because it can irritate your skin, damage body tissues such as eyes and lips.
• As advised by the Centers for Disease Control and Prevention (CDC), the best way to prevent the spread of coronavirus and reduce the likelihood of getting infected is by washing our hands with soap and water for at least 20 seconds, especially after going to the bathroom; before and after meals; and after coughing, sneezing, or blowing one’s nose.
• If soap and water are not available, alcohol-based hand sanitizer that contains at least 60% alcohol should be used.

8. Do vitamin and mineral supplements contribute to preventing and healing patients from Covid-19?

• Micronutrients, such as vitamin B, C, D, E, zinc and magnesium, are important to maintain a well-functioning immune system and play a vital role in promoting health and nutritional well-being. 
• However, there is currently no guidance on the use of micronutrient supplements as a treatment of COVID-19.

In summary, prevention is better than cure. Always protect yourself by following the standard operation procedure (SOP) such as wear mask properly, stay at least 1m from others, get vaccinated, avoid crowds and unventilated area, practice washing and sanitizing hands often, cover coughs and sneezes with hands, clean and disinfect frequently touched area, monitor your health daily and seek for health professionals if required.

Apa itu autisme? Autisme adalah masalah perkembangan kompleks. Ia berlaku kepada kanak-kanak di antara 1 dalam 68 orang. Kanak-kanak lelaki mempunyai kemungkinan mendapat autism 4 kali lebih berbanding kanak-kanak perempuan.

Autisme mempengaruhi perkembangan otak dan memberi kesan kepada keupayaan individu untuk berkomunikasi, berinteraksi secara sosial dan belajar seperti kanak-kanak normal yang lain.

Simptom Autisme

Kesusahan untuk berinteraksi dan berkomunikasi secara sosial.

1. Kesukaran dalam emosi-sosial secara dua hala: Anak tersebut mungkin tidak dapat mempunyai perbualan secara dua hala, tidak menunjukkan minat kepada orang lain, ataupun tidak memulakan atau memberi respon kepada interaksi sosial seperti bercakap “hai” atau mengajak kawan lain untuk bermain.

2. Kesukaran dalam komunikasi tidak verbal: Anak ini mungkin menunjukkan gejala hubungan mata yang sangat rendah dengan orang lain, mungkin menghadapi kesukaran dalam menunjukkan gerak geri atau tidak dapat mengikut gerak geri orang dewasa seperti orang dewasa menunjuk kearah sesuatu.

3. Tidak memberi respons apabila nama dipanggil. Kerana mereka tidak memberikan tumpuan semasa dipanggil atau tiada konteks mata dan keinginan untuk berkomunikasi kerana lebih memilih untuk bermain sendirian sahaja.

Tingkah Laku Yang Terhad Atau Berulang

1. Pergerakan, penggunaan objek atau percakapan yang berulang. Anak ini mungkin mengulangi pergerakan motor dan aksi berulang kali, seperti mengepakkan tangan, berpusing atau melompat, mengulangi perkataan atau ayat yang sama, atau mungkin berinteraksi dengan permainan berulang seperti menyusun mainan atau memusingkan objek secara berterusan.

2. Minat yang sama dan terhad kepada sesuatu perkara sahaja. Anak ini mungkin menunjukkan ikatan yang kuat kepada minat tertentu seperti karakter kartun, permainan dan topik yang tertentu.

3. Hiper- atau hipo-reaktiviti terhadap penerimaan sensori. Anak ini mungkin tidak mengendahkan sensitiviti terhadap cahaya, bunyi, kesakitan, suhu, tekstur dan pergerakan dalam persekitaran mereka. Misalnya, mereka sangat seronok untuk melompat dan merempuh barang, mencari atau mengelak cahaya terang dan bunyi yang kuat, sama seperti kemahuan untuk menyentuh, menghidu atau menjilat sesuatu objek.

Komplikasi

Seseorang yang menghidap autisme akan mendapat gejala yang berlainan mengikut umur masing-masing.

• Peringkat awal kanak-kanak – Hiperaktif, panas baran
• Peringkat akhir kanak-kanak – suka menyerang, mencederakan diri sendiri
• Peringkat remaja dan dewasa – kemurungan dan epilepsi

Rawatan

Standard emas untuk rawatan autisme adalah Rawatan Tingkah Laku Intensif menggunakan pendekatan Analisis Tingkah Laku Gunaan ( Applied Behavioral Analysis ABA)

Tiada ubat yang dapat menyembuhkan autisme tetapi ada beberapa jenis ubat yang dapat mengawal gejala-gejala yang timbul disebabkan autisme seperti:

• Berkelakuan ganas
• Hiperaktif
• Masalah tidak mampu fokus
• Kebimbangan yang mungkin timbul

Pemantauan Perkembangan Awal Kanak-Kanak

Sila dapatkan nasihat dari pihak profesional jika anak anda terlepas salah satu perkembangan di bawah:

4 Bulan

Memberi pandangan tepat
Mula membuat bunyi
Tersenyum apabila melihat orang lain

6 Bulan

Memberi respons apabila nama dipanggil
Mula membuat bunyi ”ah”, ”eh”, ”oh”
Boleh berguling dari posisi baring ke meniarap

9 Bulan

Memahami perkataan ”tidak”
Duduk tanpa sokongan
Boleh menggunakan jari untuk tunjuk kemahuan

12 Bulan

Berjalan dengan sokongan
Mempunyai 1 hingga 3 perkataan
Boleh menggelengkan kepala untuk nyatakan ”tidak” dan melambaikan ”bye”.

Gout is a crystal-induced arthritis. A condition that resulted from deposition of monosodium urate (MSU) crystals in various tissues (eg joints, connective tissue, kidney) due to elevated serum urate level. 

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation.
The normal uric acid level for adult male is 2.5-7.0 mg/dL. whereas for adult female is 1.5-6.0 mg/dL.

RISK FACTOR

1) Diet

Diet with purine-rich food will cause body to produce too much uric acids which form MSU crystal and gout.
Example of purine rich food: red meat, shellfish, drinking beverages sweetened with fruit sugar (fructose), alcohol consumption, especially of beer.

2) Weight

It is likely that higher BMI increases the risk of gout by increasing the serum uric acid level. Hyperuricemia has been associated with obesity via both increased production and decreased renal excretion of urate.

3) Medical Conditions

Some underlying medical conditions can increase the risk of developing gout, including:
– High blood pressure
– Diabetes
– Kidney disease
– High levels of cholesterol in blood

4) Certain Medications

Certain medications can increase your uric acid levels and your risk of developing gout. These include:
– Diuretics: used to treat high blood pressure or an abnormal build-up of fluid in your body
– Certain medicines used to treat high blood pressure: Beta-blockers and ACE inhibitors
– Low-dose aspirin: used to reduce the risk of blood clots

5) Family History

Gout is caused by a combination of genetic and environmental factors. Patients with family history of gout will have an increase risk of developing gout too.

SIGN AND SYMPTOMS

Gout is always associated with the symptoms of sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints. In patients with acute gout attack, joints of the lower limbs are more affected than upper limbs. It will usually last for few days to 3 weeks with a gradual complete resolution of the inflammation. For acute gout attack, it is usually monoarticular. However, gout will progress into chronic gout when the patients does not have a good control on their diet or uric acid level. For chronic gout, it is usually polyarticular arthritis and the formation of tophi.

STAGES OF GOUT

1) Acute Gout

Acute gout commonly present as an acute, self-limiting, mono-articular inflammatory arthritis. Joint at the lower limbs are more affected than the upper limbs. The affected joints will have erythema (redness of the skin), warmth and swelling over the joint. Fever may be present.
Attack of acute gout last for a few days to 2-3 weeks, with a gradual complete resolution of all inflammatory sign

2) Chronic Gout

Chronic gout present with polyarticular arthritis and the formation of tophi. Tophi are chalky deposits of MSU crystal. They are subcutaneous and painless. They will appear as a firm, nodular or fusiform swellings. Tophaceous disease more likely occur in patients where serum urate level more than 9mg/dl.
Sites of tophi includes digit of the hands and feet (most common), pinna of the ear, bursa around elbows and knees, achilles tendon (tendon that connect calf muscle to heel).

DIAGNOSIS OF GOUT

Clinical diagnosis of gout is based on whether the patients experience two or more of the following criteria:

1. Presence of clear history of at least two attacks of painful joint swelling with complete resolution within 2 weeks.
2. A clear history or observation of podagral
3. Presence of tophus
4. Rapid response to colchicine within 48 hours of starting treatment. 

TREATMENT

A) Medications

– NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended as the first treatment for gout. They work by reducing pain and inflammation during an attack.
Example: Indomethacin, Naproxen, Diclofenac, Celecoxib

– Colchicine
If NSAIDs are ineffective, a medicine called colchicine can be used instead.
Colchicine reduces some of the swelling and pain associated with a gout attack. When taken in high doses, side effects of colchicine include feeling sick, abdominal pain and diarrhea.

– Corticosteroids
Corticosteroids are sometimes used to treat severe cases of gout if other treatments don’t work or unable to take an NSAIDs or colchicine.
A short course of steroid tablets often provides relief, but they can’t be used long-term in high doses as they cause side effects, including weight gain, osteoporosis, muscle weakness.

– Allopurinol
Allopurinol helps reduce the production of uric acid. It can help prevent gout attacks, although it won’t help relieve symptoms during an attack.

B) Alternative treatment

– Urinary Alkalinizer
Sodium citrate is metabolized to bicarbonates which increases urinary pH by increasing the excretion of free bicarbonate ions without producing systemic alkalosis when administered in recommended doses. (Ural: 1-2 sachet dissolved in water for four times a day)
 A rise in urinary pH increases the solubility of cystine in the urine and the ionization of uric acid to more soluble urate ion. By maintaining an alkaline urine, the actual dissolution of uric acid stones may be accomplished.

– Cherry Juice
According to studies, tart cherry reduce uric acid because of the ingredients anthocyanins. Anthocyanin have its anti-inflammatory effect which makes cherry juice a natural anti-inflammatory. Hence, this will help to resolve gout swelling in patient.

– Celery Extract
Studied shown that celery extract have significantly reduced the serum uric acid, lipid peroxidation, and increase activity of antioxidant enzyme levels in gouty rats. This may be due to the inhibition of xanthine oxidase activity.

– Juniper Berry
Juniper is traditionally known as a diuretic, it was valued as a urinary and kidney remedy in Europe and the Mediterranean. The American ethnic physicians used Juniper berry to treat arthritic gout because of the inhibition of xanthine oxidase. Juniper berry is noted to exert powerful antioxidant activity. It also has anti-inflammatory, analgesic, and hepatoprotective effects.

LIFESTYLE ADVICES

Certain lifestyle changes can also help reduce your risk of experiencing further attacks of gout, including:

– Avoiding foods containing high levels of purine such as red meat, offal, oily fish, seafood and foods containing yeast extract.

– Avoid alcohol intake.
Alcohol disrupts the removal of uric acid from the body. Normally, purines would break down into uric acid and get flushed out of the body through urine. However, this process is interrupted when uric acid levels get too high. Crystals form around the joints, and gout develops.
To prevent gout attack, avoid alcohol during attack and avoid beer.

– Avoid sugary drinks and snacks – these are associated with an increased risk of gout.

– Maintain a healthy weight – follow a balanced diet with high-protein, low-carbohydrate diets.

– Drink plenty of water – keep yourself well-hydrated will reduce the risk of crystals forming in your joints.

– Take regular exercise – try activities that do not put too much strain on your joints, such as swimming.

Body weight is one of many determinants of health. Maintaining a healthy body weight can lower your risks towards many weight-related diseases and health issues. However, each person’s healthy weight range will vary and depend on factors such as age, gender, genetics, body frame, existing medical history and lifestyle habits. So, weight management is a process of adopting long-term lifestyle modification to maintain a healthy body weight on the basis of these factors.

You may assess your body weight status via two simple physical examination methods:

Body mass index (BMI)

BMI is a person’s weight in kilograms divided by the square of height in meters. A high BMI can indicate high body fatness, and a low BMI can indicate too low body fatness.

• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to 24.9, it falls within the normal or healthy weight range.
• If your BMI is 25.0 to 29.9, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.

Waist Circumference

Another way to estimate your potential disease risk is to measure your waist circumference. It is also a good estimate of visceral fat, the dangerous internal fat that coats the organ. Waist circumference measurement correlates well with abdominal fat content irrespective of the BMI. It is most useful in individuals who are in the normal and overweight categories of BMI. Your waistline may be telling you that you have a higher risk of developing obesity-related conditions if you are:

• A man whose waist circumference is more than 40 inches
• A non-pregnant woman whose waist circumference is more than 35 inches

Being too thin (underweight) or obese (overweight), both may impact your health condition. Maintaining a healthy weight is not only important for improving your physical appearance but is also beneficial for your overall well-being. Prioritizing weight management not only lowers the health risks but can also lead to an improved quality of life.

Underweight is a condition when energy intake is less than energy expenditure, it may lead to health risks such as malnutrition, decreased immune function, osteoporosis, infertility, developmental delays, and increased risk of surgical complications 2. A person may be underweight due to genetics, improper metabolism, lack of appetite, over-exercising, certain medicines, and underlying medical problems such as overactive thyroid, anorexia, etc 3.

Overweight and obesity are consequence of an energy imbalance where energy intake has exceeded energy expenditure over a considerable period of time, lead to abnormal or excessive fat accumulation that presents a risk to health. Obesity is one side of the double burden of malnutrition, and today more people are obese than underweight in every region. It once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. The World Health Organization (WHO) reported one in five Malaysian adults will be obese by 2025 4. Obese and overweight people are more prone to illnesses and conditions such as diabetes, hypertension, heart diseases, gall bladder diseases and osteoarthritis. Obesity may influence the risk of cancers of the colon, rectum, prostate, gall bladder, cervix, endometrium and ovary. Obesity also affects mobility, physical endurance and other functional measures. Obese people may also have low self-esteem 5.

Factors Weight Gain

Poor diet and overeating

Poor eating habits are probably the leading cause of obesity among all others. More often than not, people are likely to gain weight when they consume more calories than they burn through physical activity. Examples of unhealthy eating choices that directly lead to weight gain include:

• Eating more portions than your body needs
• Eating excessive amounts of processed or fast food
• Consuming beverages with too much sugar content
• Drinking too much alcohol 6

Physical inactivity

Another important factor is the lack of physical exercise. Nowadays, most people’s work desk jobs that consist of sitting and staring at a computer for long hours every day. When it comes to leisure activities, many of us prefer to lounge around and binge-watch or scroll endlessly on our phones instead of heading out to exercise. If you fail to incorporate exercise into your daily lives, the energy provided by the food you eat will only be stored by the body to become fat, which can lead to excessive weight gain 6.

Stress, emotional factors, and poor sleep

Some people eat more than usual when they are bored, angry, upset, or stressed. This “stress eating” are due to secretion of stress hormone called cortisol in our body. It increases appetite and may ramp up desire to eat fatty, salty or sugary “comfort foods” 7.  Studies also have found that the less people sleep, the more likely they are to have overweight or obesity. This is partly because hormones that are released during sleep help control appetite and the body’s use of energy 8.

Health Conditions

On fairly rare occasions, obesity could be caused by certain health conditions. Examples of medical conditions that commonly contribute to weight gain include hormonal imbalance, hypothyroidism and Cushing’s syndrome. Other medical problems such as arthritis can hinder one from engaging in physical activity, which can ultimately result in weight gain as well. Certain medicines also may cause weight gain, including some corticosteroids, antidepressants, and seizure medicines 8.

Ways to Achieve Healthy Weight

Healthy eating

Healthy eating features a variety of healthy foods. Fad diets may promise fast results, but such diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run. A healthy eating plan shall:

• Emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Include a variety of protein foods such as seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds.
• Is low in added sugars, sodium, saturated fats, trans fats, and cholesterol.
• Stay within your daily calorie needs 9.

Exercise regularly and stay physically active

Engaging in physical activity is one of the simplest ways to get rid of excess weight on your body. The more you exercise, the more calories your body burns off. On top of burning fat, exercising also increases your metabolism significantly 6. The World Health Organization (WHO) recommended regular exercise 60 minutes per day for children and 150 minutes per week for adults, to lower the risk or overweight and obesity 4.

Set smart weight goals

Losing or gaining weight does not happen overnight. A good and healthy weight loss or weight gain should adopt the concept of energy balance as its guiding principle. Setting a SMART goal should be specific, measurable, achievable, relevant and timely. For example, if your BMI is 23 kg/m2 and above, losing 10% to 15% of your current body weight over 6 months at a rate of 0.5 kg to 1 kg a week is a healthy target 10.

Last but not least, a heathy and successful weight management include regular monitoring of your progress and maintenance of healthy weight in the long term. Making lifestyle modifications goes beyond the physical aspects, this requires you to tap into your mental stamina as well. Believe it or not, your outlook or mindset can play an essential role in your weight management journey.

Reference:

1. Assessing Your Weight. (2022, June 3). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
2. Marcin, A. (2017, May 15). 6 Health Risks of Being Underweight. Healthline. Retrieved September 10, 2022, from https://www.healthline.com/health/underweight-health-risks
3. Underweight | Office on Women’s Health. (n.d.). Retrieved September 10, 2022, from https://www.womenshealth.gov/healthy-weight/underweight
4. Obesity. (2020, February 21). Retrieved September 10, 2022, from https://www.who.int/health-topics/obesity#tab=tab_1
5. Surainee bt. Wahab. (2012, April 20). Weight Management. PORTAL MyHEALTH. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/assessing/index.html
6. Homage. (2022, January 4). Weight Management Programmes by Doctors in Singapore. Retrieved September 10, 2022, from https://www.homage.sg/resources/weight-management/
7. Harvard Health. (2021, February 15). Why stress causes people to overeat. Retrieved September 10, 2022, from https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat
8. National Heart, Lung, and Blood Institute. (2012). What causes overweight and obesity? Retrieved September 10, 2012, from https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity
9. Physical Activity for a Healthy Weight. (2022, June 16). Centers for Disease Control and Prevention. Retrieved September 10, 2022, from https://www.cdc.gov/healthyweight/physical_activity/index.html
10. HealthHub. (n.d.). Retrieved September 10, 2022, from https://www.healthhub.sg/live-healthy/410/Healthy%20Weight

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused due to a defect in an enzyme called glucose-6-phosphate dehydrogenase that causes red blood cells to break down prematurely.

G6PD is an enzyme that protects the red blood cells from damage and destruction by harmful and toxic compounds that form in the body under certain conditions like stress, fever, or following the ingestion of certain foods or drugs. The enzyme generates compounds that can neutralize the toxic compounds formed in the body.

Causes of G6PD

It is an X-linked disorder that may be inherited from mother (usually a healthy carrier) or affected father to son or daughter. G6PD cannot be spread from one person to another. [1]

Sign and Symptoms of G6PD

People with G6PD deficiency do not display any signs of the disease until they are exposed to certain chemicals in food or drugs whereby their RBC being broken down in excess.

Other symptoms:

• Sudden rise of body temperature
• Dark yellow-orange urine
• Weak and rapid pulse rate.

It is common for babies to have jaundice (yellowing of the skin and eyes) in the first week of life, but some babies with G6PD deficiency have jaundice for longer than usual.

Diagnosis of G6PD

• Blood tests

Blood tests may reveal low red blood cell count, increased bilirubin levels, and increased plasma hemoglobin levels. Other blood tests may confirm presence of intravascular hemolysis. However, the blood tests may be normal between the attacks.

• Blood film examination

Examination of a stained blood film under the microscope may show abnormal broken red cells (hemolytic RBCs). Special stains show denatured hemoglobin within red cells (Heinz bodies) and increased immature red cells (reticulocytes) due to formation of new red cells (erythropoiesis) by the bone marrow as compensatory response. If the abnormal cells have the appearance of a bitten piece they are termed bite cells.

• Urine tests

The urine specimen during the attack is dark colored and positive for hemoglobin and hemosiderin

• Screening tests to detect low G6PD levels

Several screening tests are available that demonstrate the decreased capacity of G6PD deficient cells to reduce dyes. The enzyme can also be directly assayed.

Drugs to Avoid

Foods and Chemical to Avoid

• Fava Beans (broad beans)
• Red wine
• Henna dyes used for tattoo & Hair
• Blueberries [also yogurts containing these]
• Soya products
• Tonic water
• Naphthalene (moth balls)

References:

1. The Royal Children’s Hospital Melbourne. (n.d.). Retrieved from https://www.rch.org.au/kidsinfo/fact_sheets/g6pd_deficiency/
2. Schick P. (Dec 2018) Glucose-6-Phosphate Dehydrogenase Deficiency. Medscape. Available from http://emedicine.medscape.com/article/200390- overview.
3. MIMS 158th Edition Sep 2019 Malaysia. Drugs and Other Substances to Avoid in G6PD Deficiency. Pg 174-177

COVID-19 has been existing for more than one and half years now. At the outset of COVID-19 pandemic, the symptoms and the risks of it had been emphasized from time to time to all the citizens. However, new variants of coronavirus are always out there as these coronaviruses are constantly changing themselves rapidly through a process known as mutation.

The cycle of mutation will occur continuously leading to the emergence of new variants. As these viruses change, they will become more diverse and the symptoms if infected will be changed as well. A major concern right now in our country is the highly transmissible and fast-spreading Delta variant. Delta variant was first documented in India in October 2020. Delta variant is believed to be up to 60% more contagious compared to the Alpha variant and it will become the dominant variant of the coronavirus soon. It was first identified in Malaysia in early July 2021 and has led to another wave of COVID-19 here. This Delta variant may cause a higher hospitalization rate and more severe complications to humans. The incubation period will be shortened to 3 to 7 days compared to 2 weeks in the Alpha variant. Delta variant usually attacks the elderlies and people with weakened immune response. Infection caused by Delta variant will progress quickly leading to severe cases in just 3 to 4 days. Some might even be admitted into the ICU in 24 hours. The Delta variant is so much more contagious as it has higher viral load, it is better at infecting people who are not sufficiently immuned. Delta variant is transmitting at a very high speed with a ratio of 1:4, meaning that 1 infected person might spread the viruses to 4 persons and so on in the same space, same unit or even same building. In order to break the chain of transmission, ones should practice social distancing at a distance of at least 2.5m.

Comparison Among Different Coronavirus Variants
There are 4 main variants of coronaviruses around the world right now which are Alpha (B.1.17), Beta (B.1.35), Gamma (P.1) and Delta (B.1.617) variants. The following shows some differences among these strains of virus:

Figure 2: Differences Among Alpha, Beta, Gamma and Delta Variant

 Common Symptoms Caused by Delta Variant

The symptoms of COVID-19 will evolve in pace with the evolution of the virus strains. Other than the usual symptoms like fever and cough, there are some additional symptoms of the Delta variant that we need to pay attention at such as:

Effectiveness of Vaccines on Delta Variant        
Vaccination appears to show some benefits against Delta variant, even though there is less protection provided by the vaccine compared to other variants of coronaviruses. The following data show the efficacy rates of the vaccine against the symptomatic infections caused by Delta variant by some studies.

Furthermore, vaccinated people are less likely to get hospitalized against Delta variant. The efficacy rates against hospitalization are showed below:

The best way to combat the Delta surge is still the vaccination as fully vaccinated people are having lower risk to be threatened by Delta variant. However, new variants will continue to appear as long as there are large number of unvaccinated people around the world and a new version of the Delta variant, known as Delta Plus is already circulating in other part of the world. If this Delta Plus abroad our country, the unvaccinated communities in our country remain at risk of getting infection.

Reference:
1. The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for [Internet]. The Conversation. 2021 [cited 17 July 2021]. Available from: https://theconversation.com/the-symptoms-of-the-delta-variant-appear-to-differ-from-traditional-covid-symptoms-heres-what-to-look-out-for-163487

2. Jay Hilotin S, Shyam A. Krishna S, Alex Abraham S, Seyyed Llata S. Alpha, Beta, Gamma, Delta COVID-19 variants: How dangerous? [Internet]. Gulfnews.com. 2021 [cited 17 July 2021]. Available from: https://gulfnews.com/special-reports/alpha-beta-gamma-delta-covid-19-variants-how-dangerous-1.1624872935207

3. How effective are coronavirus vaccines against the Delta variant? [Internet]. Ft.com. 2021 [cited 17 July 2021]. Available from: https://www.ft.com/content/5a24d39a-a702-40d2-876d-b12a524dc9a5

4. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2021 [cited 17 July 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html

5. How effective are COVID-19 vaccines against the Delta variant? [Internet]. Los Angeles Times. 2021 [cited 17 July 2021]. Available from: https://www.latimes.com/science/story/2021-07-02/how-well-do-covid-19-vaccines-cover-the-delta-variant

6. Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile | NEJM [Internet]. New England Journal of Medicine. 2021 [cited 17 July 2021]. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2107715?fbclid=IwAR0ITkADdmafRq8Bx_ce33cDrA72htAxooODiEd6dhFXf1WDyCQw1qoK3O8

What is high altitude sickness?

Ascending to or being at a new high altitude may cause high-altitude sickness. High altitude sickness includes acute mountain sickness (AMS), high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE). High altitude sickness is a condition that occurs when people ascend to high altitudes (usually above 8,000 feet or 2,400 meters) too quickly without acclimatizing properly. Altitude sickness is caused by a lack of oxygen in the air, which can lead to a range of symptoms that can range from mild to life-threatening.

Acute mountain sickness (AMS)

Acute mountain sickness (AMS) is the most common of the altitude diseases; it occurs in approximately 40 to 50 percent of people who live at a low altitude and sleep at an altitude above 10,000 feet (3000 m), and in approximately 25 percent of those sleeping above 8000 feet (2400 m). Some people can develop AMS as low as 6500 feet (2000 m).

High-altitude cerebral edema (HACE)

High-altitude cerebral edema (HACE) is a rare, life-threatening altitude disease and is a severe form of acute mountain sickness (AMS). It is caused by leaky capillaries in the brain, which causes fluid accumulation and brain swelling. You may experience confusion, lack of coordination and possibly violent behaviour.

High-altitude Pulmonary Edema (HAPE)

High-altitude pulmonary edema (HAPE) is a potentially fatal condition in which lung capillaries leak and fluid accumulates in the lungs, causing breathlessness, even when resting. You feel very fatigued and weak and may feel like you’re suffocating. HAPE is uncommon but can occur in people who rapidly ascend to altitudes above 8200 feet (2500 m).

Symptoms

The symptoms of high-altitude sickness can range from mild to severe and usually appear within 6 to 24 hours after arrival at high altitude. The most common symptoms include:

• Headache
• Nausea
• Vomiting
• Fatigue
• Loss of appetite
• Dizziness
• Insomnia
• Shortness of breath
• Rapid heart rate

In severe cases, high altitude sickness can progress to high altitude cerebral edema (HACE) or high altitude pulmonary edema (HAPE), which can be life-threatening.

Risk Factors

It is not possible to know in advance if you will become ill when traveling to a high altitude. In addition, being physically fit does not decrease your chances of developing a high-altitude illness. However, certain groups are at increased risk, including people who:

• Have a prior history of high-altitude illness
• Overexert themselves before adjusting to the change in altitude
• Ascend rapidly (eg, within one day) from low elevation to sleeping altitudes above 9000 feet (2750 m)
• Have a medical problem that affects breathing

Treatment

The treatment for high altitude sickness depends on the severity of the condition. Mild symptoms of altitude sickness can often be relieved by descending to a lower altitude, resting, oxygen therapy and taking over-the-counter pain medications such as acetaminophen or ibuprofen. However, more severe cases of altitude sickness may require medical attention. Here are some treatments for high altitude sickness:

1. Medication

• Acetazolamide (Diamox) can help alleviate symptoms of altitude sickness by stimulating breathing and reducing fluid buildup in the lungs. However, it is important to consult with a healthcare provider before taking any medication.
• Dexamethasone is a steroid medication that can be used to treat severe cases of altitude sickness, such as high altitude cerebral edema (HACE).

2. Oxygen therapy

If you experience severe altitude sickness symptoms, oxygen therapy may be necessary to alleviate symptoms and prevent further complications.

Prevention

1. Gradual ascent. The best way to prevent high altitude sickness is to acclimatize properly. This involves gradually ascending to higher altitudes over several days, allowing the body to adjust to the lower oxygen levels.
2. Staying hydrated. Dehydration can worsen altitude sickness symptoms. Drink plenty of fluids, even if you don’t feel thirsty.
3. Eating a well-balanced diet. Eat a diet that’s more than70% carbohydrate as can help provide the energy and nutrients needed to cope with the physical stress of high altitude.
4. Avoiding alcohol. Alcohol can dehydrate your body. It also has stronger effects at higher elevations, which can impair judgment.
5. Rest. Take it easy for the first few days after reaching high altitude. Avoid strenuous activity until you feel acclimatized.
6.  “Climb high and sleep low”. If you have to climb over 1,000 feet in a day, make sure you come back down to a lower altitude to sleep.
7. Recognize symptoms. Be aware of the symptoms of altitude sickness and take action if they appear. Early recognition and treatment can prevent the condition from becoming more severe.

References

1. Altitude Sickness: What to Know?. https://www.webmd.com/a-to-z-guides/altitude-sickness
2. Altitude sickness. https://www.nhs.uk/conditions/altitude-sickness/#:~:text=You%20can%20get%20altitude%20sickness,a%20medical%20emergency%20if%20ignored.
3. Patient education: High-altitude illness (including mountain sickness) (Beyond the Basics). https://www.uptodate.com/contents/high-altitude-illness-including-mountain-sickness-beyond-the-basics/print
4. Cleveland Clinic. Altitude Sickness. Available from https://my.clevelandclinic.org/health/diseases/15111-altitude-sickness